Additional E-mail Sign-up

NEThabitat
(tel)+27 (0)82 322 6044
(fax) +27 (0)18 294 7162
info@nethabitat.co.za

This is an official application form for an additional NEThabitat e-mail account. Should you require a dial-up account, please fill in the Internet Access form.

Personal Detail
Company Name:
Contact Person:
Postal Address:
Physical Address:
Phone Number:
Fax Number:
Cell phone:
Preferred E-mail Address:
By Submitting this Order form, I have read and agreed to the service contract and system policies.

� 2001 NEThabitat
Last updated: Friday, October 12, 2001
info@nethabitat.co.za